Guest editorial: Systemic inequity in Ventura County’s mental health system

The Civil Rights Movement was led by advocates courageously confronting the erroneous belief that some of us are more valuable and important than others. They marched in protest to challenge the racial segregation that had been eloquently defended by politicians and enforced by police.

The neglect and criminalization of people with mental illness is the civil rights and social justice issue of our time. People with mental illnesses continue to face stark inequities borne from stigmatizing beliefs about their worth. You won’t see them marching in protest.

Marginalized groups share histories of systemic oppression, segregation, and a denial of basic human rights. But the distinctive feature of mental illness discrimination is that it causes impairment. Dr. Martin Luther King Jr. stated, “of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

The inhumanity these individuals and their families face goes unquestioned by leaders because this is a voiceless population. When those with the power to do something stand by, support the status quo, and place arbitrary restrictions on rights and freedoms — when they tolerate this injustice through silent complicity and fail to work toward providing the same quality of health care enjoyed by persons with other health conditions — this is evidence of structural stigma.

Structural/institutional stigma embedded in the status quo of local governments has created vast disparities and is the most significant barrier to the well-being of people with mental illness. These inequities are evident in their disproportionate overrepresentation in our jails and on our streets and in the failures of decision-makers to plan for their care, forcing them to remain untreated or waiting for days in emergency rooms only to receive substandard care. For any other health condition, these injustices would never be tolerated.

We waste millions on anti-stigma campaigns aimed at changing society’s attitudes, but it is the leaders with the power to do something who must commit to the principles of equity and justice to exercise their moral and ethical responsibility to bring change.

I spent six years on Ventura County’s mental health board witnessing structural stigma. I observed the lack of investment in wellness and recovery; I watched millions of dollars approved by Supervisors for programs focused on people with mild mental health challenges, while the population most in need kept cycling, untreated, through restrictive environments.

I watched top leadership display a belief that some people’s basic human rights are open for debate when they stated, “we are doing more than we have to” for this population. I listened to countless families whose loved ones were passed from law enforcement to hospitals, to out-of-county facilities, to jails, and to homelessness. 

Appropriate levels of care are not available — people who are unstable and acutely ill are placed in the wrong environments — sober living homes or board and cares. And those who are not acutely ill stay in intensive settings because there is nowhere for them to go.  

Leaders who are responsible for making decisions about mental health care should know that their silence and inaction is influenced by structural stigma. They should work toward solutions instead of continuing to endorse an inhumane status quo.

Mary Haffner, a partner in the law firm of Haffner Law Group, served on the Ventura County Behavioral Health Advisory Board from 2015-2021. She was Secretary of the Board and co-chair of the Laura’s Law Implementation Workgroup. She currently serves on the Board of Directors for the Los Angeles Chapter of Physicians for Social Responsibility.